Community acquired pneumonia

Question 1

Markers suggesting pneumonia needing admission

• physical exam (5)
• investigation (2)

(ref - etg)

Answer 1

Physical
Confusion
o2 sats <= 92%
tachycardia > 100
systolic blood pressure < 90
tachypnea >22

investigation
multilobar involvement
serum lactate level > 2.0

Question 2

risk factors for developing community acquired pneumonia (CAP) (10)
(ref - https://pubmed.ncbi.nlm.nih.gov/28738364/)

Answer 2

personal, lifestyle

• age
• malnutrition
• smoking
• environmental exposure

medication

• antacid use
• immunosuppressive therapy

pmhx

• poor dental health
• past CAP
• asthma
• COPD/chronic bronchitis

Question 3

community acquired pneumonia - definition

ref - etg

Answer 3

pneumonia that develops in a patient in the community, in hospital for < 48 hours

Question 4

most common bacterial pneumonia pathogen

Answer 4

streptococcus pneumoniae

Question 5

investigations for suspected pneumonia

Answer 5

chest xray

blood lactate

Question 6

community acquired pneumonia treatment - first line, duration for

• low severity
• low severity, rural and remote
• atypical pathogens
• penicillin sensitive

Answer 6

first line - amoxicillin 1g PO TDS
rural and remote - procaine benzylpenicillin 1.5g IM OD
atypical, penicillin sensitive - doxycycline 100mg BD or clarithromycin 500mg BD

duration determined by treatment response at 48hours. 5 days if improving, 7 days if slow improvement.

Question 7

community acquired pneumonia treatment (low severity)

• when to consider combination therapy (2)
• what to use

Answer 7

• if risk of missed follow up in 48 hours
• if poor response at 48 hours

add-on doxycycline 100mg BD or clarithromycin 500mg BD
use cefuroxime 500mg PO BD if nonsevere penicillin hypersensitivity